Impact of Race and Ethnicity on Presentation and Surgical Outcomes of Idiopathic Macular Holes

Abstract

There is limited data on the presentation and surgical outcomes of idiopathic macular holes (IMH) for different ethnic and racial groups. Recognition of distinct, clinically-relevant patient subgroups may provide opportunities to identify specific unmet needs including possible barriers to optimal healthcare delivery. Medical records of patients who underwent surgery for IMH (between 2016 and 2022) at a large, urban retina practice were reviewed and self-reported ethnicity (Hispanic and non-Hispanic) and race (Asian, Black, White, and Other) were captured. The primary variables included (1) mean minimum linear diameter (MLD) at presentation and (2) surgical outcome (IMH closure status). Overall, mean MLD for all study eyes (515) was 366.1 μm, and surgical success was achieved in 489 (95.0%) eyes. Hispanic eyes presented with larger mean MLD (p = 0.002) compared to non-Hispanic eyes. Asian, Black, and Other eyes presented with larger mean MLD (p = 0.033, p < 0.001, p < 0.001) when compared to White eyes. The presentation of IMH varied in severity among different ethnic and racial groups. Hispanic patients were found to have worse preoperative visual acuity (VA), longer time to surgery, and larger mean MLD and BD compared to non-Hispanic participants. Black and Other patients were found to have worse VA, time to surgery, and larger mean MLD and BD when compared to White participants.

Keywords: diversity; ethnicity; idiopathic macular hole; race; retina.

Figure 1

OCT image measurement with distance overlay tool. Minimum linear diameter (MLD) (A) was measured between nearest ends of broken macular tissue in the scan with the widest hole dimensions. Basal diameter (BD) (B) was measured at the level of the retinal pigment epithelium.

Figure 2

Logarithmic time to surgery distribution by (A) ethnicity (Hispanic or non-Hispanic) and (B) race (Asian, Black, White, or Other).

Figure 3

Minimum linear diameter (MLD) distribution by (A) ethnicity (Hispanic or non-Hispanic) and (C) race (Asian, Black, White, or Other). Basal diameter (BD) distribution by (B) ethnicity and (D) race. All MLD and BD measurements were taken preoperatively.

Figure 4

Comparison of follow-up visits by (A) ethnicity (Hispanic or non-Hispanic) and (B) race (Asian, Black, White, or Other). The four time points indicated are the preoperative visit (month 0), 1-month postoperative visit, 6-month postoperative visit, and 12-month postoperative visit.

Figure 5

Mean logMAR visual acuity by (A) ethnicity (Hispanic or non-Hispanic) and (B) race (Asian, Black, White, or Other). The four time points indicated are the preoperative visit (month 0), 1-month postoperative visit, 6-month postoperative visit, and 12-month postoperative visit.

Figure 6

Comparison of successful and unsuccessful surgery outcomes by (A) follow-up visits attended (in percentage total) and (B) mean logMAR visual acuity. The four time points indicated are the preoperative visit (month 0), 1-month postoperative visit, 6-month postoperative visit, and 12-month postoperative visit.